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13090041 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21685 GRANADA AVE CONTRACTOR:SP HOME PERMIT NO: 13090041 IMPROVEMENT OWNER'S NAME: TIAN HUA 1030 WINDSOR ST DATE ISSUED:01232014 OWNER'S PHONE: 4087688413 SAN JOSE,CA 95129 PHONE NO:(408)777-8918 } LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] TENANT IMPROVEMENT TO CHANGE THE USE FROM License Class Li,.# �,��IF3gea BUSINESS Contractorr7 �UMt -1 M�viDate tr 2 a. - LD1/-� TO EDUCATION(2080 SQ FT). I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent-to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35717032.00 Occupancy e: permit is issued. p y Typ APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WI7*�IIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes, (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 3 ,1 granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point source regulations per the Cupertino Municipal Code,Secti 9.18. �/' RE-ROOFS: Signature Date —t s: ..lJ t� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the-following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDQUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Healtb&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Arca Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owncr or authorized agent: .. Date:t r permit is issued. g I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with-such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and stats that the above information is correct.I agree to comply wfth all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18, Signature Date 10 CONSTRUCTION PERMIT APPLICATION � 1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION rr.1, V 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �u CUi'ERTINO (408)777-3228•FAX(408)777-3333•buildincr(aDcupertinD.org ❑ NF W CONSTRUCTION ❑ ADDITION ALTERATION I TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS t f '^ r�L1 /� r APN# -7 OWNER NAME , VP-4q2,7( 'a"84 E-MAIL STREET ADDRESS CITY,STATE,P.IP o FAX � 1 C S� �ANi9'D� ra'si1� Cc! '�'(I� C,f? .�58� CONTACT NAME PHONE E-MAIL �vE8— �yt'T -4b ��--r�t� j c�a err, Cal STREET ADDRESSCITY,STATE,ZIP 4 FAX t�2C�g C -eW_r �v Ca 4s-�t4 ❑OWNER ❑ OWNER-DUaMn ❑ OWNER AGSM ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHrrEcT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ' LICENSE NUMBER LICENSE TYPE BUS.LIC H COMPANY NAME &MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCFHTECTIENGWEERNAME.yt j r� v� LICENSE NUMBER 3� BUS.LIC 0 � CzI COMPANY NAME E-MAIL PAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 1) AOA 57�5 PtTH Rba M e) "P H t-�n/ s C tJ5r G b�JL= ? a/r EXISTING USE PROPOSED USE CONSTR.TYPE I #STORES C� J_=�U CA-1-1 CA, 2 USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL `RE 2 bPa C3 AREA 2 f�. AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA � REMODELAREA �!� REMODELARFA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 4 ATTACH #DWELLINGUNn'S: IS A SECOND UNrr ❑YES SECOND STORY ❑YES 'N(^ BEINGADDED! ❑NO ADDITION! ❑NO PRE-APPLICATION I YYES IF YES,PROVIDE COPY OF IS THE BLDG AN YES RECEIVED'$Y: TOTAL VALUATION: PLANNINGAPPL# 0 P G APPROVALLETTER EICIILERHOME! D i O -e— By my signature below,I rtify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rel ilding construe' I authorize representatives of Cupertino to enter the above-identified property for inspection purposes, Signature of Applicant/A eriv Date: eq SUPPLEMENTAL INFORMATION REQ D PLAN CHECK TYPE _ ROUtMG SLIP _New SFD or Multifamily dwellings: Apply for demolition permit forInOVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior t0 issuance of building permit for new building. -El EXPRESS PLANNFNG PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLrc WORKS Tor—in if any Hazardous Materials are being used as part of this project. [7 inxcE FIRE DEPT 7,%*Copy of Planning Approval Letter or Meeting with Planning prior to E] MAJOR ❑ SANITARY SEWER DISTRICT of Building Permit application.`' lI L� OY ❑ ENVIRONMENTAL HEALTH BidgApp 201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ' ADDRESS: 21665 granada ave DATE: 09/06/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: j$10,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMITTYPE: 1GENCOM WORK ada improvements to include bathroom ramp and arking stall SCOPE Mech,Plan Check Phimb,Plan CheckF-T Elea Plan Check "_,Ch. Permit 1''oe; Plumb.Permit Fee: F.lec.Pennit Fee: Other tllech.Insp. Other Plumb Insp. Li Other Elec.Insp. Lj Ilech. hap.Fee: Plumb.Irrsy.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prefindua information available and are on an estimate- Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? •©Yes (F) No $0.00 2 hours Plan Check,Hourly Suppl.PC Fee. (F) Reg. Q OT 0.0 hrs $0.00 $278.00 1sTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee.0 Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tor: Administrative Fee: Q Work Without Permit? ©Yes Q No $0.00 E) Advanced Planning Fee. $0.00 Select a Non-Residential Trcn,el Documentation Fees: Building or Structure Strom Motion Fee: IBSEISMICO $2.10 3.0 hrs Inspections Bldg Stds Commission Fee: IBCBSC $1:00 $417.00 isTINSP Inspection,Hourly SUBTOTALS: $3.10 $695.00 " �� TOTAL FEE:°' $698.10 Revised: 07/0112013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: a l{ s C'OA&Wp4 PERMIT# 1 3 0 04 OWNER'S NAME: 71 A&) QA PHONE# IfV - 8 DS- D 2.2- GENERAL GENERAL CONTRACTOR: 75P 404r, 1 M iQ00C-Niz7A)T BUSINESS LICENSE# r 3 I3 ADDRESS: 1430 W(x),DS c A 57. .5,14N "'05,2 CITY/ZIPCODE: 2 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: a'`` PaLt _ :L3 — 2-0 14 '---�' Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring l Carpeting Linoleum l Wood Glass 1 Glazing Heating Insulation Landscaping Lathing Masonry Painting l Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date